Medical Reimbursement

[Wallbanger]

I have a question about medical reimbursement. My wife became ill on a cruise, and we paid $2500 to Carnival for onboard medical care. My health insurance sent me a notice that they paid $1400 of this claim, and I found out it went to a company contracted by Carnival. The illness was nine months ago, and I received this notice recently but have not received any reimbursement as yet, but it seems I should have this portion of my payment returned. Has anyone had a similar experience and if so, how long did it take to receive reimbursement?

[Babr]

My question is why the reimbursement went to a company contracted by Carnival.

 

Did you file a claim with your health insurance with documents and receipts that you had already paid for the medical services? I think I’d start by calling your insurance company to ask them where they sent your money and why.

 

 

[jimbo5544]

Lots of questions.  Have you contacted Carnival?  Why did your insurance not pay the remainder?  Have you had regular correspondence with insurer?  Are they disputing the difference?    

[BlerkOne]

4 hours ago, Wallbanger said:

I have a question about medical reimbursement. My wife became ill on a cruise, and we paid $2500 to Carnival for onboard medical care. My health insurance sent me a notice that they paid $1400 of this claim, and I found out it went to a company contracted by Carnival. The illness was nine months ago, and I received this notice recently but have not received any reimbursement as yet, but it seems I should have this portion of my payment returned. Has anyone had a similar experience and if so, how long did it take to receive reimbursement?

Does your insurance have a $2500 deductible?

[janice2348]

Deleted

Edited August 17, 2023 by janice2348

[janice2348]

9 minutes ago, BlerkOne said:

Does your insurance have a $2500 deductible?

Deleted

Edited August 17, 2023 by janice2348

[BlerkOne]

6 minutes ago, janice2348 said:

It would still not go to Carnival even with a deductible.  If the OP has a deductible of $2500, and paid out of pocket $1400, it would go toward his deductible, not Carnivals affiliate. Doctors don’t get paid twice. 

If the bill exceeded $2500, and the OP had a $2500 deductible, the OP would owe Carnival at least $2500.

 

Apparently the insurance company paid Carnival $1400, so the total bill must have been at least $3900.

 

 

Edited August 17, 2023 by BlerkOne

[Lee Cruiser]

2 minutes ago, BlerkOne said:

If the bill exceeded $2500, and the OP had a $2500 deductible, the OP would owe Carnival at least $2500.

 

Apparently the insurance company paid Carnival $1400, so the total bill must have been at least $3900.

 

 

I'm guessing the OP would understand his deductible.  Having been to the medical center before, I know Carnival requires payment upon service and does not file or wait on insurance to pay.  I read it as the total bill was $2,500, which they would have been required to pay in entirety before debarking.  He then filed it with his insurance and the insurance ended up sending the reimbursement to Carnival instead of back to him.

[Babr]

6 minutes ago, Lee Cruiser said:

I'm guessing the OP would understand his deductible.  Having been to the medical center before, I know Carnival requires payment upon service and does not file or wait on insurance to pay.  I read it as the total bill was $2,500, which they would have been required to pay in entirety before debarking.  He then filed it with his insurance and the insurance ended up sending the reimbursement to Carnival instead of back to him.

That is the way I understand it. The reimbursement was only $1,400 because his insurance did not approve all the charges and may have paid at out-of-network rates as well.

 

It appears he did not have travel insurance to pay the remaining balance.

[Lee Cruiser]

56 minutes ago, jimbo5544 said:

Lots of questions.  Have you contacted Carnival?  Why did your insurance not pay the remainder?  Have you had regular correspondence with insurer?  Are they disputing the difference?    

It would probably be because it would be out of network.  When I had to go to the Carnival physician years ago, it was billed to my account.  They gave me the receipt and form to file with my insurance.  Mine was much less at around $250 or so if I remember correctly.  My insurance reimbursed me at around 70% I believe.  My current insurance would be about 50% out of network.

[BlerkOne]

2 minutes ago, Lee Cruiser said:

I'm guessing the OP would understand his deductible.  Having been to the medical center before, I know Carnival requires payment upon service and does not file or wait on insurance to pay.  I read it as the total bill was $2,500, which they would have been required to pay in entirety before debarking.  He then filed it with his insurance and the insurance ended up sending the reimbursement to Carnival instead of back to him.

If that is the case, the insurance company messed up, but only the insurance company knows why they did what they did.

[icft]

7 hours ago, Wallbanger said:

I have a question about medical reimbursement. My wife became ill on a cruise, and we paid $2500 to Carnival for onboard medical care. My health insurance sent me a notice that they paid $1400 of this claim, and I found out it went to a company contracted by Carnival. The illness was nine months ago, and I received this notice recently but have not received any reimbursement as yet, but it seems I should have this portion of my payment returned. Has anyone had a similar experience and if so, how long did it take to receive reimbursement?

My best guess is that your insurance company treated this as a request by you to pay the provider rather than as a reimbursement of an amount you already paid.

 

My first step would be to contact my insurance company and ask why they sent the money to the provider. If you filled out your claim forms indicating you had already paid and were requesting reimbursement and your insurance company made a mistake then I would try to put it all on them to get the incorrect payment back from the provider and get your money to you. If you filled out the claim form as a "I got this bill from my provider please pay" then it is probably on you to stalk the provider for reimbursement.

 

I'm just guessing. Good luck.

[Wallbanger]

17 hours ago, Lee Cruiser said:

I'm guessing the OP would understand his deductible.  Having been to the medical center before, I know Carnival requires payment upon service and does not file or wait on insurance to pay.  I read it as the total bill was $2,500, which they would have been required to pay in entirety before debarking.  He then filed it with his insurance and the insurance ended up sending the reimbursement to Carnival instead of back to him.

Thanks for the responses. The total bill was $2500 which was paid to my onboard account. My health insurance paid the $1400 to the contracted medical provider. I did contact Carnival who simply said they did not receive payment. I contacted my health insurance company, and they are providing me documents and contact information for the company they paid. Once this is resolved I can file on my travel insurance for the balance. There was no deductible involved and frankly I was pleasantly surprised my insurance company paid anything.  I was hoping someone might have experienced a similar situation.  

[WendyVF]

You should go back to your health insurance company for them to pay it in full.  I've had to do this several times.  They have an obligation to provide a network and if there were no network providers where you needed emergency care, they have to pay as if in network.  

[staceyglow]

I am pretty sure this could all be answered by calling the insurance company. 

[mjkacmom]

1 hour ago, WendyVF said:

You should go back to your health insurance company for them to pay it in full.  I've had to do this several times.  They have an obligation to provide a network and if there were no network providers where you needed emergency care, they have to pay as if in network.  

I don’t believe they have to provide medical care outside the US, which is why many people pay for travel insurance so they can be reimbursed outside of the country.

[sanger727]

I don't believe that most of the posters are even reading the OP's post. The post isn't about how to get the medical bill they paid reimbursed. It's about the fact that the insurance company said they "paid" the medical provider directly, except the OP already paid the medical provider directly so are owed reimbursement. The poster seems primarily concerned with how to prove the insurance company paid the medical provider directly so they can be issued the appropriate refund.

Edited August 18, 2023 by sanger727

[Babr]

5 hours ago, Wallbanger said:

Thanks for the responses. The total bill was $2500 which was paid to my onboard account. My health insurance paid the $1400 to the contracted medical provider. I did contact Carnival who simply said they did not receive payment. I contacted my health insurance company, and they are providing me documents and contact information for the company they paid. Once this is resolved I can file on my travel insurance for the balance. There was no deductible involved and frankly I was pleasantly surprised my insurance company paid anything.  I was hoping someone might have experienced a similar situation.  

Carnival didn’t receive the payment. As you said earlier, the payment went to a company Carnival contracts to administer the billing and payments for the medical services provided on the ship. The doctors are vendors not full-time employees of Carnival.

 

Somehow the reimbursement was misdirected, but it seems you are now on the right track to get it resolved so that you can file with your travel insurance if you have not missed the window to submit a claim since the illness was nine months ago.